Visit-to-visit HbA 1c variability is associated with in-stent restenosis in patients with type 2 diabetes after percutan
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ORIGINAL INVESTIGATION
Cardiovascular Diabetology Open Access
Visit‑to‑visit HbA1c variability is associated with in‑stent restenosis in patients with type 2 diabetes after percutaneous coronary intervention Chen Die Yang1†, Ying Shen1†, Lin Lu1,2, Zhen Kun Yang1, Jian Hu1, Rui Yan Zhang1, Wei Feng Shen1,2*, Feng Hua Ding1* and Xiao Qun Wang1,2*
Abstract Background: Patients with type 2 diabetes are under substantially higher risk of in-stent restenosis (ISR) after coronary stent implantation. We sought to investigate whether visit-to-visit HbA1c variability is a potential predictor of ISR in diabetic patients after stent implantation. Methods: We consecutively enrolled type 2 diabetic patients who underwent successful elective percutaneous coronary intervention and performed follow-up coronary angiography after around 12 months. The incidence of ISR and its relationship with visit-to-visit HbA1c variability, expressed as coefficient of variation (CV), standard deviation (SD) and variability independent of the mean (VIM), were studied. Multivariable Cox proportional hazards models were constructed to analyze the predictive value of HbA1c variability for ISR. Results: From September 2014 to July 2018 in Ruijin Hospital, a total of 420 diabetic patients (688 lesions) after stent implantation were included in the final analysis. During a mean follow-up of 12.8 ± 1.3 months, the incidence of ISR was 8.6%, which was significantly increased in patients with higher CV of HbA1c (P = 0.001). The mean diameter stenosis (DS), net luminal loss and net luminal gain were 22.9 ± 16.8%, 0.42 ± 0.88 mm and 1.66 ± 0.83 mm, respectively. Greater DS was observed in subjects with higher tertiles of CV of H bA1c (P 50% within the stent or in the 5-mm proximal or distal segments adjacent to the stent at follow-up angiography. For the purpose of this study and to avoid confounding serum data, patients who had acute coronary syndrome (n = 86) during initial angiography and PCI, familial hypercholesterolemia (n = 5), malignant tumor (n = 13), or renal failure requiring hemodialysis (n = 8) were excluded. Another 36 subjects with no hematological and biochemical indices at admission were further excluded. All these patients received a quarterly clinical evaluation, routine analyses and HbA1c measurements. Follow-up coronary angiography was performed after around 12 months and all the enrolled patients were reminded by telephone in advance. During follow-up, 5 patients died and 68 patients were lost to follow-up. For calculation of HbA1c variability, subjects (n = 279) without at least three HbA1c measurements during follow-up (≥ 3 months apart) were also excluded. The remaining 420 subjects constituted the study population (Fig. 1). The diagnosis of type 2 diabetes was made according to the criteria of American Diabetes Association [symptoms of diabetes with casual plasma glucose concentration ≥ 200 mg/dL (11.1 mmol/L) or fasting plasma glucose ≥ 126 mg/dL (7.0 mmol/L), 2 h postprandial glucose ≥ 200 mg/dL (11.1 m
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